A Novel Intervention for Avoidance-Related Opioid Misuse in Patients with Cancer

针对癌症患者与避免相关的阿片类药物滥用的新型干预措施

• 批准号: 10654523
• 负责人: Miryam Yusufov
• 金额: $ 15.12万
• 依托单位: DANA-FARBER CANCER INST
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10654523
• 关键词: Address; Advanced Malignant Neoplasm; Anxiety; Area; Award; Behavior; Behavior Therapy; Behavioral; Behavioral Model; Behavioral trial; Cancer Patient; Categories; Center for Translational Science Activities; Chemicals; Clinic; Clinical Research; Clinical Sciences; Comprehensive Cancer Center; Dana-Farber Cancer Institute; Data; Development; Dissemination and Implementation; Education; Enrollment; Ensure; Environment; Evaluation; Evidence based program; Face; Feedback; Foundations; Fracture; Future; Goals; Government; Health; Health behavior; Individual; Infection; Intervention; Intervention Trial; Interview; Malignant Neoplasms; Manuals; Measures; Mental Depression; Mentorship; Methods; Monitor; Oncology; Opioid; Outcome; Outpatients; Pain; Pain management; Palliative Care; Participant; Patients; Persons; Pharmaceutical Preparations; Phase; Pilot Projects; Population; Population Intervention; Preparation; Prevention; Procedures; Process; Public Health; Qualitative Methods; Quality of life; Randomized; Randomized, Controlled Trials; Recording of previous events; Replacement Therapy; Reporting; Research; Research Personnel; Resources; Risk; Risk Behaviors; Risk Factors; Risk Management; Risk Reduction; Running; Scientist; Social support; Stress; Substance Use Disorder; Targeted Research; Testing; Therapeutic Intervention; Training; United States National Institutes of Health; Visit; Waiting Lists; acceptability and feasibility; behavior change; behavioral outcome; cancer care; cancer pain; care outcomes; career; career development; coping; design; disorder risk; experience; high risk population; immune function; intervention refinement; medical schools; neurotoxicity; novel; opioid misuse; opioid therapy; patient engagement; patient oriented research; pilot test; pilot trial; prescription opioid; primary outcome; programs; psychologic; psychological distress; psychological outcomes; psychosocial; reduced substance use; remote delivery; substance use; success; symptom management; therapy development

Project Summary/Abstract Between 18% and 56% of patients with cancer misuse opioids. Opioid misuse can result in worse healthcare outcomes, such as neurotoxicity, infection, and compromised immune functioning. Further, it predisposes patients to developing substance use disorder (SUD). People living with cancer have multiple risk factors for developing SUD and face unique prevention and risk management issues. Anxiety and depression (i.e., psychological suffering) that drive avoidant coping increase SUD risk in patients with cancer. While specific psychological risk factors for opioid misuse have been identified, no interventions targeting these factors currently exist to reduce SUD risk in this population. Uncoupling psychological suffering and opioid misuse represents an opportunity to reduce SUD risk and better enable individuals with cancer to use their opioids as prescribed. The framework of Acceptance and Commitment Therapy (ACT) appears ideally suited for this problem. Since substance use interventions are most effective when tailored to populations, patients would be best served through an intervention specifically designed for individuals with cancer on opioid therapy. This study seeks to: (1) refine a behavioral intervention targeting SUD risk and psychological suffering in individuals with cancer; (2) pilot test the tailored intervention for this population; and (3) estimate effect sizes for an adequately- powered RCT. Dr. Yusufov’s career goal is to leverage her background in health behavior risks to conduct patient-oriented research that addresses psychological suffering and substance use in individuals with cancer. The integrated training and research plans proposed in this revised application will provide Dr. Yusufov with advanced training in several critical areas needed to enhance her program of research toward this career goal. With mentorship and guidance from national leaders in palliative care, psychosocial oncology, substance use, patient engagement methods, and ACT, the training is targeted to the following domains: (1) research in palliative care (Dr. James Tulsky), (2) SUD treatment (Dr. Kathryn McHugh), (3) development/testing of psychosocial interventions, patient-oriented research, and patient engagement methods (Dr. Joseph Greer), (4) clinical research in palliative care/psychosocial oncology (Dr. William Pirl), and (5) adaptation of ACT interventions (Dr. Kristy Dalrymple). These training objectives will be achieved through a combination of didactic/applied activities in a Stage I behavioral trial involving pilot testing. Dana-Farber Cancer Institute and Harvard Medical School provide an outstanding environment for these training and research objectives, including clinics supportive of patient-oriented research, seminars/courses in designated training areas, and a highly active Clinical and Translational Science Center with a wide array of resources for career development and training. This K08 award will provide an essential bridge between Dr. Yusufov’s prior training and experience and her career goal of becoming an independent scientist conducting patient-oriented research to reduce the public health burden of SUD risk in cancer settings by targeting underlying psychological suffering.

项目总结/摘要 18%至56%的癌症患者滥用阿片类药物。阿片类药物滥用可能导致更糟糕的医疗保健 结果，如神经毒性，感染和免疫功能受损。此外，它倾向于 物质使用障碍（Substance Use Disorder，SUD）癌症患者有多种危险因素， 发展SUD并面临独特的预防和风险管理问题。焦虑和抑郁（即， 心理痛苦），驱动回避应对增加SUD风险的癌症患者。虽然具体 已确定阿片类药物滥用的心理风险因素，没有针对这些因素的干预措施 目前存在降低该人群SUD风险的方法。分离心理痛苦和阿片类药物滥用 代表了降低SUD风险并更好地使癌症患者能够使用阿片类药物的机会， 规定的。接受和承诺疗法（ACT）的框架似乎非常适合这一点 问题.由于物质使用干预措施在针对人群时最有效， 最好通过专门为接受阿片类药物治疗的癌症患者设计的干预措施来提供服务。本研究 寻求：（1）完善针对SUD风险和心理痛苦的行为干预， 癌症;（2）对该人群进行量身定制的干预措施进行试点测试;（3）估计充分- 动力RCT Yusufov博士的职业目标是利用她在健康行为风险方面的背景， 以患者为导向的研究，解决癌症患者的心理痛苦和物质使用问题。 本修订申请中提出的综合培训和研究计划将为Yusufov博士提供 在几个关键领域的高级培训需要加强她的研究计划朝着这个职业目标。 在姑息治疗、心理社会肿瘤学、药物使用、 患者参与方法和ACT，培训针对以下领域：（1）姑息治疗研究 护理（James Tulsky博士），（2）SUD治疗（Kathryn McHugh博士），（3）开发/测试心理社会 干预措施，以病人为导向的研究，和病人参与的方法（约瑟夫格里尔博士），（4）临床 姑息治疗/心理社会肿瘤学研究（William Pirl博士），以及（5）ACT干预措施的适应性（William Pirl博士）。 Kristy达林普尔）。这些培训目标将通过教学/应用活动相结合来实现 在第一阶段的行为试验中，包括试点测试。丹娜-法伯癌症研究所和哈佛医学院 为这些培训和研究目标提供良好的环境，包括支持以下方面的诊所： 以患者为导向的研究，指定培训领域的研讨会/课程，以及高度活跃的临床和 翻译科学中心拥有广泛的职业发展和培训资源。K 08获奖 将提供Yusufov博士之前的培训和经验与她的职业目标之间的重要桥梁， 成为一名独立的科学家，进行以病人为导向的研究，以减少公共卫生负担， 通过针对潜在的心理痛苦在癌症环境中的SUD风险。